Module 6 : Violence & Drug Use

What kind of help can I get?

*Domestic violence agencies provide:* - Emotional support - Safety planning - A safe place to stay in an emergency - Legal help - Help with housing

What are the types of distraction?

*There are three main types of distraction:* *Visual:* taking your eyes off the road; *Manual:* taking your hands off the wheel; and *Cognitive:* taking your mind off of driving.

Cocaine

- A powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Possible Health Effects: *Short-term* - Narrowed blood vessels; enlarged pupils; increased body temperature, heart rate, and blood pressure; headache; abdominal pain and nausea; euphoria; increased energy, alertness; insomnia, restlessness; anxiety; erratic and violent behavior, panic attacks, paranoia, psychosis; heart rhythm problems, heart attack; stroke, seizure, coma. *Long-term* - Loss of sense of smell, nosebleeds, nasal damage and trouble swallowing from snorting; infection and death of bowel tissue from decreased blood flow; poor nutrition and weight loss from decreased appetite. *Other Health-related Issues* - Pregnancy: premature delivery, low birth weight, smaller head circumference. Risk of HIV, hepatitis, and other infectious diseases from shared needles.

Sources and Continuing Availability

- According to CBP, many synthetic cannabinoid and cathinone products originate overseas. Law enforcement personnel have also encountered the manufacture of synthetic drugs in the U.S., including in residential neighborhoods. - Synthetic drugs are often sold at small retail outlets and are readily available via the Internet. The chemical compositions of synthetic drugs are frequently altered in an attempt to avoid government bans.

What Is drug addiction?

- Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. - These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug. - It's common for a person to relapse, but relapse doesn't mean that treatment doesn't work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient's changing needs.

Based on scientific research since the mid-1970s, the following key principles should form the basis of any effective treatment program:

- Addiction is a complex but treatable disease that affects brain function and behavior. - No single treatment is right for everyone. - People need to have quick access to treatment. - Effective treatment addresses all of the patient's needs, not just his or her drug use. - Staying in treatment long enough is critical. - Counseling and other behavioral therapies are the most commonly used forms of treatment. - Medications are often an important part of treatment, especially when combined with behavioral therapies. - Treatment plans must be reviewed often and modified to fit the patient's changing needs. - Treatment should address other possible mental disorders. - Medically assisted detoxification is only the first stage of treatment. - Treatment doesn't need to be voluntary to be effective. - Drug use during treatment must be monitored continuously. - Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.

Methamphetamine

- An extremely addictive stimulant amphetamine drug. Possible Health Effects: *Short-term* - Increased wakefulness and physical activity; decreased appetite; increased breathing, heart rate, blood pressure, temperature; irregular heartbeat. *Long-term* - Anxiety, confusion, insomnia, mood problems, violent behavior, paranoia, hallucinations, delusions, weight loss, severe dental problems ("meth mouth"), intense itching leading to skin sores from scratching. *Other Health-related Issues* - Pregnancy: premature delivery; separation of the placenta from the uterus; low birth weight; lethargy; heart and brain problems. Risk of HIV, hepatitis, and other infectious diseases from shared needles.

Can drug addiction be cured or prevented?

- As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn't a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient's drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery. - More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

The Social-Ecological Model: A Framework for Prevention

- CDC uses a four-level social - ecological model to better understand violence and the effect of potential prevention strategies. *This model considers the complex interplay between individual, relationship, community, and societal factors.* - It allows us to understand the range of factors that put people at risk for violence or protect them from experiencing or perpetrating violence. The overlapping rings in the model illustrate how factors at one level influence factors at another level. - Besides helping to clarifying these factors, the model also suggests that in order to prevent violence, it is necessary to act across multiple levels of the model at the same time. This approach is more likely to sustain prevention efforts over time than any single intervention.

CNS Depressants

- CNS depressants slow down brain activity and can cause sleepiness and loss of coordination. Continued use can lead to physical dependence and withdrawal symptoms if use is stopped. Possible Health Effects: *Short-term*- Drowsiness, slurred speech, poor concentration, confusion, dizziness, problems with movement and memory, lowered blood pressure, slowed breathing. *Long-term* - Physical dependence, withdrawal, possibility of seizures from rebound effect. *Other Health-related Issues* - Sleep medications are sometimes used as date rape drugs (e.g. Rohypnol). Risk of HIV, hepatitis, and other infectious diseases from shared needles *In Combination with Alcohol* - Further slows heart rate and breathing, which can lead to death.

Government Efforts to Ban Synthetic Drug Products

- Congress has taken steps to ban many of these substances at the Federal level, and the Administration has supported such efforts. - The Synthetic Drug Abuse Prevention Act is part of the FDA Safety and Innovation Act of 2012, signed into law by President Obama. The law permanently places 26 types of synthetic cannabinoids and cathinones into Schedule I of the Controlled Substances Act (CSA). It also doubled the maximum period of time that the Drug Enforcement Administration (DEA) can administratively schedule substances under its emergency scheduling authority, from 18 to 36 months. - The Controlled Substance Analogue Enforcement Act of 1986 allows many synthetic drugs to be treated as controlled substances if they are proven to be chemically and/or pharmacologically similar to a Schedule I or Schedule II controlled substance. - In 2011, DEA exercised its emergency scheduling authority to control five types of synthetic cannabinoids, and three of the synthetic substances used to manufacture synthetic cathinones. In 2012, all but one of these substances were permanently designated as Schedule I substances under the Synthetic Drug Abuse Prevention Act, and the remaining substance was permanently placed into Schedule I by DEA regulation. - On April 12, 2013, DEA used its emergency scheduling authority to schedule three more types of synthetic cannabinoids, temporarily designating them as Schedule I substances. - At least 43 states have taken action to control one or more synthetic cannabinoids. Prior to 2010, synthetic cannabinoids were not controlled by any State or at the Federal level. In addition, at least 44 states have taken action to control one or more synthetic cathinones.

Distracted driving activities

- Distracted driving activities include things like using a cell phone, texting, applying makeup, and eating. Using in-vehicle technologies (such as navigation systems) can also be sources of distraction. While any of these distractions can endanger the driver and others, texting while driving is especially dangerous because it combines all three types of distraction.

What about cost?

- Domestic violence agencies offer free services, like hotlines, counseling, and help finding resources such as housing or lawyers.

Young adult and teen drivers

- Drivers under the age of 20 have the highest proportion of distraction-related fatal crashes. - The national Youth Risk Behavior Surveillance System (YRBSS) monitors health-risk behaviors among high school students, including sending texts while driving. - In 2013, more than two out of five students who drove in the past 30 days sent a text or email while driving.Those who text while driving are nearly twice as likely to ride with a driver who has been drinking. - Students who frequently text while driving are more likely to ride with a drinking driver or drink and drive than students who text while driving less frequently.

Consequences of Drug Abuse

- Drug abuse is a serious public health problem that affects many communities and families in some way. Each year drug abuse causes millions of serious illnesses or injuries among Americans. - Drug abuse also plays a role in many major social problems, such as drugged driving, violence, stress, and child abuse. Drug abuse can lead to homelessness, crime, and missed work or problems with keeping a job. It harms unborn babies and destroys families. There are different types of treatment for drug abuse. But the best is to prevent drug abuse in the first place.

POINTS TO REMEMBER

- Drug addiction can be treated, but it's not simple. - *Addiction treatment must help the person do the following*: stop using drugs, stay drug-free , be productive in the family, at work, and in society *Successful treatment has several steps:* - detoxification - behavioral counseling - medication (for opioid, tobacco, or alcohol addiction) - evaluation and treatment for co-occurring mental health issues such as depression and anxiety long-term follow-up to prevent relapse - Medications can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions. Behavioral therapies help patients:modify their attitudes and behaviors related to drug usei ncrease healthy life skills persist with other forms of treatment, such as medication. People within the criminal justice system may need additional treatment services to treat drug use disorders effectively. However, many offenders don't have access to the types of services they need

POINTS TO REMEMBER

- Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. - Brain changes that occur over time with drug use challenge an addicted person's self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease. - *Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.* - Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again. - Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high. - No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. - Drug addiction is treatable and can be successfully managed. - More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Distracted Driving

- Each day in the United States, over 8 people are killed and 1,161 injured in crashes that are reported to involve a distracted driver.Distracted driving is driving while doing another activity that takes your attention away from driving. Distracted driving can increase the chance of a motor vehicle crash.

Drugs don't just hurt the person taking them. Everyone connected to the person can get hurt. Drug abuse can cause many problems:

- Fighting and violence in and outside the home - Money problems - Trouble at school - Trouble at work, losing a job - Trouble in relationships - Child abuse, neglect - Driving accidents - Arrests and jail - When you or a loved one abuse drugs, everyday life can feel out of control.

Plan for your safety.

- If you are in a relationship with someone who is violent or might become violent, make a plan to keep yourself safe. This is important whether you are planning to leave your partner or not.

Start with a phone call.

- If you need help or have questions about your relationship, call the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233). You'll be able to find a domestic violence agency near you or talk to a counselor over the phone. If you are in danger right now, call 911.

Protecting Yourself from Relationship Violence

- If you think your partner might be controlling or abusive, it's important to: - Trust your feelings. If something doesn't seem right, take it seriously. - Learn the warning signs of someone who might become controlling or violent. - Get help. Talk to experts in relationship violence. - If your partner is controlling or abusive, it's better to get help now than to wait. Controlling or violent relationships usually get worse over time. *Remember: if your partner hurts you, it's not your fault.*

Health Effects of Drug Abuse

- In addition to the effects various drugs of abuse may have on specific organs of the body, many drugs produce global body changes such as dramatic changes in appetite and increases in body temperature, which may impact a variety of health conditions. Withdrawal from drug use also may lead to numerous adverse health effects, including restlessness, mood swings, fatigue, changes in appetite, muscle and bone pain, insomnia, cold flashes, diarrhea, and vomiting.

Intimate Partner Violence

- Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term "intimate partner violence" describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy. *The goal is to stop IPV before it begins.* - Programs that teach young people skills for dating can prevent violence. These programs can stop violence in dating relationships before it occurs.IPV can vary in frequency and severity. It occurs on a continuum, ranging from one episode that might or might not have lasting impact to chronic and severe episodes over a period of years.

What if I'm not sure if my relationship is violent?

- It's okay if you aren't sure - you can still get help. Domestic violence agencies have counselors who are experts at helping people with questions about their relationships. You don't even have to give your name. - If you think your partner is controlling or abusive, take steps to protect yourself.

Individual Risk Factors

- Low self-esteem - Low income - Low academic achievement - Young age - Aggressive or delinquent behavior as a youth - Heavy alcohol and drug use - Depression - Anger and hostility - Antisocial personality traits - Borderline personality traits - Prior history of being physically abusive - Having few friends and being isolated from other people - Unemployment - Emotional dependence and insecurity - Belief in strict gender roles (e.g., male dominance and aggression in relationships) - Desire for power and control in relationships - Perpetrating psychological aggression - Seeing or being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration) - History of experiencing poor parenting as a child - History of experiencing physical discipline as a child

Understanding Drug Use and Addiction

- Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What is being done?

- Many states are enacting laws—such as banning texting while driving, or using graduated driver licensing systems for teen drivers—to help raise awareness about the dangers of distracted driving and to keep it from occurring. However, the effectiveness of cell phone and texting laws on decreasing distracted driving-related crashes requires further study. *The Insurance Institute for Highway Safety keeps track of such laws.*

Relationship Factors

- Marital conflict-fights, tension, and other struggles - Marital instability-divorces or separations - Dominance and control of the relationship by one partner over the other - Economic stress - Unhealthy family relationships and interactions

How are medications used in drug addiction treatment?

- Medications can be used to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions.

Withdrawal.

- Medications help suppress withdrawal symptoms during detoxification. Detoxification is not in itself "treatment," but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014).

Opioids:

- Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine®), and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug seeking and related criminal behavior and help them become more open to behavioral treatments.

Examples of abused drugs include:

- Methamphetamine - Anabolic steroids - Club drugs - Cocaine - Heroin - Inhalants - Marijuana - Prescription drugs

What happens to the brain when a person takes drugs?

- Most drugs affect the brain's "reward circuit" by flooding it with the chemical messenger dopamine. This reward system controls the body's ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable "high" that can lead people to take a drug again and again. - As a person continues to use drugs, the brain adjusts to the excess dopamine by making less of it and/or reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high. It can also cause them to get less pleasure from other things they once enjoyed, like food or social activities.

Tobacco

- Nicotine replacement therapies have several forms, including the patch, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.

Why do some people become addicted to drugs while others don't?

- No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example: *Biology*. - The genes that people are born with account for about half of a person's risk for addiction. *Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.* *Environment.* A person's environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction. *Development.* Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. *Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.*

Co-occuring conditions

- Other medications are available to treat possible mental health conditions, such as depression or anxiety, that may be contributing to the person's addiction.

Prescription Opioids

- Pain relievers with an origin similar to that of heroin. Opioids can cause euphoria and are often used nonmedically, leading to overdose deaths. Possible Health Effects: *Short-term* - Pain relief, drowsiness, nausea, constipation, euphoria, confusion, slowed breathing, death. *Long-term* - Physical dependence, possible brain damage. *Other Health-related Issues* - - Pregnancy: Miscarriage, low birth weight, neonatal abstinence syndrome. - Older adults: higher risk of accidental misuse or abuse because many older adults have multiple prescriptions, increasing the risk of drug-drug interactions, and breakdown of drugs slows with age; also, many older adults are treated with prescription medications for pain. Risk of HIV, hepatitis, and other infectious diseases from shared needles. *In Combination with Alcohol* - Dangerous slowing of heart rate and breathing leading to coma or death

Can drug addiction be treated?

- Yes, but it's not simple. Because addiction is a chronic disease, people can't simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using completely and recover their lives.

Relapse prevention

- Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use.

Misperceptions

- People often misperceive (or misunderstand) social norms and overestimate the number of people who behave in unhealthy ways or who accept unhealthy behavior. Researchers have studied college students' misperceptions of social norms related to alcohol use. They've found that most college students do not enjoy heavy drinking. However, they tend to think that heavy drinking is the norm among their peers and overdrink to fit in. Misperceptions can be harmful when a person alters their own beliefs and behaviors based on a false assumption about other people's beliefs and behaviors.

Risk Factors for Intimate Partner Violence

- Persons with certain risk factors are more likely to become perpetrators or victims of intimate partner violence (IPV). Those risk factors contribute to IPV but might not be direct causes. Not everyone who is identified as "at risk" becomes involved in violence. A combination of individual, relational, community, and societal factors contribute to the risk of becoming an IPV perpetrator or victim. Understanding these multilevel factors can help identify various opportunities for prevention.

There are four main types of IPV:

- Physical violence, Sexual violence, Stalking, Psychological Aggression

Relationship violence can include:

- Physical violence, like pushing, hitting, or throwing things - Sexual violence, like forcing or trying to force someone to do something sexual - Threats of physical or sexual violence, which may include threatening to hurt another person or a pet Emotional abuse, like embarrassing a partner or keeping that person away from family and friends - *If you feel controlled by or afraid of your partner - even if you haven't been hurt physically - trust yourself. There are people who can help you figure out what to do next.*

Community Factors

- Poverty and associated factors (e.g., overcrowding) - Low social capital-lack of institutions, relationships, and norms that shape a community's social interactions - Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)

How do I know if my relationship might become violent?

- Relationship violence can start slowly and be hard to recognize at first. For example, when people first start dating, it's common to want to spend a lot of time together. But spending less time with other people can also be a sign that your partner is trying to control your time. - Try asking yourself these questions: *Does my partner respect me? Does my partner blame me for everything that goes wrong? Does my partner make most of the decisions in our relationship? Am I ever afraid to tell my partner something? Do I ever feel forced to do things that I don't want to do? Have I ever done anything sexual with my partner when I didn't want to? Does my partner promise to change and then keep doing the same things?*

What is relationship violence?

- Relationship violence is when one person in a relationship is abusive or controlling toward the other person - especially when they disagree about something. - *Relationship violence is sometimes called dating violence, domestic violence, or intimate partner violence. In some relationships, both partners act in abusive or controlling ways.* - When many people think about relationship violence, they think about physical violence, like hitting or pushing. But people can also use other methods, like threats or insults, to control their partners.

Social Norms and Violence

- Social norms can affect nearly any aspect of our lives. They contribute to our clothing choices, how we speak, our music preferences, and our beliefs about certain social issues. They can also affect our attitudes, beliefs, and behaviors related to violence. The way we react to violence may be based on what we see other people do, or how we think other people would act. In other words, our reactions are based on what we believe is normal or appropriate.

What are Social Norms?

- Social norms refer to values, beliefs, attitudes, and/or behaviors shared by a group of people. They are often based on what people believe to be normal, typical, or appropriate. Social norms can function as unspoken rules or guidelines for how people behave, and for how people are expected to behave. People generally follow social norms because they want to fit in with the people around them. - Social norms can result in positive or negative outcomes. Sometimes social norms help people behave in ways that keep themselves - and others - safe and healthy. Other times, social norms can have the opposite effect, and can lead people to behave in harmful ways.

A Rapidly Emerging Threat

- Synthetic cannabinoids laced on plant material were first reported in the U.S. in December 2008, when a shipment of "Spice" was seized and analyzed by U.S. Customs and Border Protection (CBP) in Dayton, Ohio. - There is an increasingly expanding array of synthetic drugs available. 51 new synthetic cannabinoids were identified in 2012, compared to just two in 2009. Furthermore, 31 new synthetic cathinones were identified in 2012, compared to only four in 2009. In addition, 76 other synthetic compounds were identified in 2012, bringing the total number of new synthetic substances identified in 2012 to 158.

Trust your instincts.

- You are the expert on your life and relationships. If you think your relationship is unhealthy or you are worried about your safety, trust your gut.

When family members take drugs:

- You generally can't count on them to do what they say they will do. - They may forget or get distracted because their focus is on getting and taking drugs. - They might lie or steal money to buy drugs. - They might get fired from their jobs. - They might not come home at night. - They may do bad things they would never do if they weren't abusing drugs.

Synthetic Drugs (a.k.a. K2, Spice, Bath Salts, etc.)

- Synthetic cannabinoids, commonly known as "synthetic marijuana," "K2," or "Spice", are often sold in legal retail outlets as "herbal incense" or "potpourri", and synthetic cathinones are often sold as "bath salts" or "jewelry cleaner". They are labeled "not for human consumption" to mask their intended purpose and avoid Food and Drug Administration (FDA) regulatory oversight of the manufacturing process. - Synthetic cannabinoids are man-made chemicals that are applied (often sprayed) onto plant material and marketed as a "legal" high. Users claim that synthetic cannabinoids mimic Δ9-tetrahydrocannabinol (THC), the primary psychoactive active ingredient in marijuana. - Use of synthetic cannabinoids is alarmingly high, especially among young people. According to the 2012 Monitoring the Future survey of youth drug-use trends, one in nine 12th graders in America reported using synthetic cannabinoids in the past year. This rate, unchanged from 2011, puts synthetic cannabinoids as the second most frequently used illegal drug among high school seniors after marijuana - Synthetic cathinones are man-made chemicals related to amphetamines. Synthetic cathinone products often consist of methylenedioxypyrovalerone (MDPV), mephedrone, and methylone - The Administration has been working with Federal, Congressional, state, local, and non-governmental partners to put policies and legislation in place to combat this threat, and to educate people about the tremendous health risk posed by these substances.

Risk to the Public Health

- The contents and effects of synthetic cannabinoids and cathinones are unpredictable due to a constantly changing variety of chemicals used in manufacturing processes devoid of quality controls and government regulatory oversight. - Health warnings have been issued by numerous public health authorities and poison control centers describing the adverse health effects associated with the use of synthetic drugs. - The effects of synthetic cannabinoids include severe agitation and anxiety, nausea, vomiting, tachycardia (fast, racing heartbeat), elevated blood pressure, tremors and seizures, hallucinations, dilated pupils, and suicidal and other harmful thoughts and/or actions. - Similar to the adverse effects of cocaine, LSD, and methamphetamine, synthetic cathinone use is associated with increased heart rate and blood pressure, chest pain, extreme paranoia, hallucinations, delusions, and violent behavior, which causes users to harm themselves or others.

Individual

- The first level identifies biological and personal history factors that increase the likelihood of becoming a victim or perpetrator of violence. Some of these factors are age, education, income, substance use, or history of abuse. Prevention strategies at this level are often designed to promote attitudes, beliefs, and behaviors that ultimately prevent violence. Specific approaches may include education and life skills training.

Societal

- The fourth level looks at the broad societal factors that help create a climate in which violence is encouraged or inhibited. These factors include social and cultural norms that support violence as an acceptable way to resolve conflicts. Other large societal factors include the health, economic, educational and social policies that help to maintain economic or social inequalities between groups in society.

Relationship

- The second level examines close relationships that may increase the risk of experiencing violence as a victim or perpetrator. A person's closest social circle-peers, partners and family members-influences their behavior and contributes to their range of experience. Prevention strategies at this level may include parenting or family-focused prevention programs, and mentoring and peer programs designed to reduce conflict, foster problem solving skills, and promote healthy relationships.

Community

- The third level explores the settings, such as schools, workplaces, and neighborhoods, in which social relationships occur and seeks to identify the characteristics of these settings that are associated with becoming victims or perpetrators of violence. Prevention strategies at this level are typically designed to impact the social and physical environment - for example, by reducing social isolation, improving economic and housing opportunities in neighborhoods, as well as the climate, processes, and policies within school and workplace settings.

Alcohol

- Three medications have been FDA-approved for treating alcohol addiction and a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows: *Naltrexone *blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients. *Acamprosate (Campral®) * may reduce symptoms of long-lasting withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction. *Disulfiram (Antabuse®)* interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking.

Societal Factors

- Traditional gender norms (e.g., women should stay at home, not enter workforce, and be submissive; men support the family and make the decisions)

How it affects the family

- When a person has a drug problem, they have a disease that can hurt the family. Drug abuse puts a lot of stress on parents, brothers and sisters, children, grandparents—anyone who is part of the home. - Family members might fight a lot because of the problems the drug abuse is causing. The drug user might do and say things that upset neighbors and friends, and make the family ashamed. Some people who are addicted don't believe that they are sick and out of control, so they don't look for treatment. They don't see the problems they are causing themselves and those around them. Other people who are addicted are aware of the problem, but may be so upset and confused that they do not know how to ask for or get help.

Stalking

- a pattern of repeated, unwanted, attention and contact that causes fear or concern for one's own safety or the safety of someone else (e.g., family member or friend). Some examples include repeated, unwanted phone calls, emails, or texts; leaving cards, letters, flowers, or other items when the victim does not want them; watching or following from a distance; spying; approaching or showing up in places when the victim does not want to see them; sneaking into the victim's home or car; damaging the victim's personal property; harming or threatening the victim's pet; and making threats to physically harm the victim.

Outpatient behavioral treatment

- a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. - Most of the programs involve individual or group drug counseling, or both. These programs typically offer forms of behavioral therapy such as: *cognitive-behavioral therapy*, which helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs *multidimensional family therapy*—developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning *motivational interviewing*, which makes the most of people's readiness to change their behavior and enter treatment *motivational incentives* (contingency management), which uses positive reinforcement to encourage abstinence from drugs

Inpatient or residential treatment

- can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment.

Successful treatment has several steps:

- detoxification (the process by which the body rids itself of a drug) - behavioral counseling - medication (for opioid, tobacco, or alcohol addiction) - evaluation and treatment for co-occurring mental health issues such as depression and anxiety long-term follow-up to prevent relapse - A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.

Sexual violence

- is divided into five categories. Any of these acts constitute sexual violence, whether attempted or completed. Additionally all of these acts occur without the victim's freely given consent, including cases in which the victim is unable to consent due to being too intoxicated (e.g., incapacitation, lack of consciousness, or lack of awareness) through their voluntary or involuntary use of alcohol or drugs. - *Rape or penetration of victim* - This includes completed or attempted, forced or alcohol/drug-facilitated unwanted vaginal, oral, or anal insertion. Forced penetration occurs through the perpetrator's use of physical force against the victim or threats to physically harm the victim. - *Victim was made to penetrate someone else* - This includes completed or attempted, forced or alcohol/drug-facilitated incidents when the victim was made to sexually penetrate a perpetrator or someone else without the victim's consent. - *Non-physically pressured unwanted penetration* - This includes incidents in which the victim was pressured verbally or through intimidation or misuse of authority to consent or acquiesce to being penetrated. - *Unwanted sexual contact* - This includes intentional touching of the victim or making the victim touch the perpetrator, either directly or through the clothing, on the genitalia, anus, groin, breast, inner thigh, or buttocks without the victim's consent - *Non-contact unwanted sexual experiences* - This includes unwanted sexual events that are not of a physical nature that occur without the victim's consent. Examples include unwanted exposure to sexual situations (e.g., pornography); verbal or behavioral sexual harassment; threats of sexual violence to accomplish some other end; and /or unwanted filming, taking or disseminating photographs of a sexual nature of another person.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

- learning - judgment - decision-making - stress - memory - behavior

Marijuana

- made from the hemp plant, Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol, or THC. - Possible Health Effects: *Short-term* - Enhanced sensory perception and euphoria followed by drowsiness/relaxation; slowed reaction time; problems with balance and coordination; increased heart rate and appetite; problems with learning and memory; hallucinations; anxiety; panic attacks; psychosis. *Long-term* - Mental health problems, chronic cough, frequent respiratory infections.\ *Other Health-related Issues* - Youth: possible loss of IQ points when repeated use begins in adolescence. Pregnancy: babies born with problems involving attention, memory, and problem solving.

Behavioral therapies help patients:

- modify their attitudes and behaviors related to drug use - increase healthy life skills - persist with other forms of treatment, such as medication - Patients can receive treatment in many different settings with various approaches.

Addiction treatment must help the person do the following:

- stop using drugs - stay drug-free - be productive in the family, at work, and in society

Physical violence

- the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to, scratching; pushing; shoving; throwing; grabbing; biting; choking; shaking; aggressive hair pulling; slapping; punching; hitting; burning; use of a weapon; and use of restraints or one's body, size, or strength against another person. Physical violence also includes coercing other people to commit any of the above acts.

Psychological Aggression

- the use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person. Psychological aggression can include expressive aggression (e.g., name-calling, humiliating); coercive control (e.g., limiting access to transportation, money, friends, and family; excessive monitoring of whereabouts); threats of physical or sexual violence; control of reproductive or sexual health (e.g., refusal to use birth control; coerced pregnancy termination); exploitation of victim's vulnerability (e.g., immigration status, disability); exploitation of perpetrator's vulnerability; and presenting false information to the victim with the intent of making them doubt their own memory or perception (e.g., mind games).

Heroin

Possible Health Effects: *Short-term* - Euphoria; warm flushing of skin; dry mouth; heavy feeling in the hands and feet; clouded thinking; alternate wakeful and drowsy states; itching; nausea; vomiting; slowed breathing and heart rate. *Long-term* - Collapsed veins; abscesses (swollen tissue with pus); infection of the lining and valves in the heart; constipation and stomach cramps; liver or kidney disease; pneumonia. *Other Health-related Issues* - Pregnancy: miscarriage, low birth weight, neonatal abstinence syndrome. Risk of HIV, hepatitis, and other infectious diseases from shared needles. *In Combination with Alcohol* - Dangerous slowdown of heart rate and breathing, coma, death.